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Dr. Bob is Robert Hsiung, MD,
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Posted by Schlepo on April 14, 2019, at 14:38:12
I have sort of a tricky question. Is there a way to calculate the time when the reduced dosage of a drug would take its overall effect? I'm not necessarily referring to any withdrawal effects, just whether there's a point in time when the reduction in the amount of a drug you take catches up with you. In my specific case, it's about dropping from 125mg to 75mg of nortriptyline in early January. What would be the length of time it would take for that -50mg to be fully subtracted from a steady state, I guess. Or would it just be different for everybody?
Sorry, I'm having a somewhat difficult time phrasing this inquiry just right.
Posted by linkadge on April 14, 2019, at 18:31:29
In reply to Reverse Steady State Calculation(???), posted by Schlepo on April 14, 2019, at 14:38:12
It should be fairly quick (days really). There would be some individual variation based on liver enzyme status. I know for nortriptyline, there are fast metabolizers and slow metabolizers. Even so, I can't see it taking more than a week.
Now that being said, just because the body reaches a lower steady state (blood level) in that time, doesn't mean the brain (necessarily) fully adjusts in that time. There are other factors like disease severity, receptor sensitivity etc. that will affect how quickly (or long) it takes for an individual to adjust.
Also, I think that the drug can 'build up' to some extent, in the brain. So, even if the blood levels drop, there may be a higher amount in the brain, for some time (no idea how long).
Furthermore, the downstream actions of the drug could take longer to reverse themselves. I.e. the drug immediately affects norepinephrine, but that activation can lead to downstream effects, perhaps epigenetic, that could take some time to revert.
Linkadge
This is the end of the thread.
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